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Identifying large vessel occlusion at first glance in telemedicine

BACKGROUND: Telemedicine has rapidly emerged as an important tool in emergency neurology. In particular, reliable biomarkers of large vessel occlusions (LVOs) are critically necessary in order to identify the need for in-hospital mechanical thrombectomy (MT). Based on pathophysiological factors, we...

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Autores principales: Schröter, Nils, Weiller, Antonia, Rijntjes, Michel, Harloff, Andreas, Urbach, Horst, Kukolja, Juraj, Bardutzky, Jürgen, Weiller, Cornelius, Beume, Lena-Alexandra
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10421816/
https://www.ncbi.nlm.nih.gov/pubmed/37202605
http://dx.doi.org/10.1007/s00415-023-11775-2
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author Schröter, Nils
Weiller, Antonia
Rijntjes, Michel
Harloff, Andreas
Urbach, Horst
Kukolja, Juraj
Bardutzky, Jürgen
Weiller, Cornelius
Beume, Lena-Alexandra
author_facet Schröter, Nils
Weiller, Antonia
Rijntjes, Michel
Harloff, Andreas
Urbach, Horst
Kukolja, Juraj
Bardutzky, Jürgen
Weiller, Cornelius
Beume, Lena-Alexandra
author_sort Schröter, Nils
collection PubMed
description BACKGROUND: Telemedicine has rapidly emerged as an important tool in emergency neurology. In particular, reliable biomarkers of large vessel occlusions (LVOs) are critically necessary in order to identify the need for in-hospital mechanical thrombectomy (MT). Based on pathophysiological factors, we propose that the presence of head and/or gaze deviation alone signifies cortical hypoperfusion and is therefore a highly sensitive marker for the presence of LVO. METHODS: We retrospectively analyzed a cohort of 160 patients, examined via telemedicine and suspected to have had an acute stroke; this included patients with ischemic or hemorrhagic stroke, transient ischemic attack, and stroke mimics. An assessment of head and gaze deviation and NIHSS score evaluation was performed. In a second analysis, patients who only had ischemia in the anterior circulation (n = 110) were evaluated. RESULTS: Head and/or gaze deviation alone was found to be a reliable marker of LVO (sensitivity: 0.66/specificity: 0.92), as well as a sound indicator for MT (0.82/0.91), in patients with suspected ischemic stroke. The performance of this indicator further improved when patients with ischemia in the anterior circulation only were assessed (LVO: 0.70/0.93; MT: 0.86/0.90). In both analyses, head and/or gaze deviation served as a better indicator for LVO or MT compared to the prevalence of motor deficits or aphasia. Of note, in patients who had ischemia in the anterior circulation, head and/or gaze deviation performed better than the NIHSS score as an indicator for MT. CONCLUSION: These findings confirm that the presence of head and/or gaze deviation serves as a reliable biomarker in stroke-based telemedicine for the diagnosis of LVO, as well as a strong indicator for MT. Furthermore, this marker is just as reliable as the NIHSS score but easier to assess. We therefore suggest that any stroke patient who displays head and/or gaze deviation should immediately be scheduled for vessel imaging and subsequently transported to a MT-competent center.
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spelling pubmed-104218162023-08-13 Identifying large vessel occlusion at first glance in telemedicine Schröter, Nils Weiller, Antonia Rijntjes, Michel Harloff, Andreas Urbach, Horst Kukolja, Juraj Bardutzky, Jürgen Weiller, Cornelius Beume, Lena-Alexandra J Neurol Original Communication BACKGROUND: Telemedicine has rapidly emerged as an important tool in emergency neurology. In particular, reliable biomarkers of large vessel occlusions (LVOs) are critically necessary in order to identify the need for in-hospital mechanical thrombectomy (MT). Based on pathophysiological factors, we propose that the presence of head and/or gaze deviation alone signifies cortical hypoperfusion and is therefore a highly sensitive marker for the presence of LVO. METHODS: We retrospectively analyzed a cohort of 160 patients, examined via telemedicine and suspected to have had an acute stroke; this included patients with ischemic or hemorrhagic stroke, transient ischemic attack, and stroke mimics. An assessment of head and gaze deviation and NIHSS score evaluation was performed. In a second analysis, patients who only had ischemia in the anterior circulation (n = 110) were evaluated. RESULTS: Head and/or gaze deviation alone was found to be a reliable marker of LVO (sensitivity: 0.66/specificity: 0.92), as well as a sound indicator for MT (0.82/0.91), in patients with suspected ischemic stroke. The performance of this indicator further improved when patients with ischemia in the anterior circulation only were assessed (LVO: 0.70/0.93; MT: 0.86/0.90). In both analyses, head and/or gaze deviation served as a better indicator for LVO or MT compared to the prevalence of motor deficits or aphasia. Of note, in patients who had ischemia in the anterior circulation, head and/or gaze deviation performed better than the NIHSS score as an indicator for MT. CONCLUSION: These findings confirm that the presence of head and/or gaze deviation serves as a reliable biomarker in stroke-based telemedicine for the diagnosis of LVO, as well as a strong indicator for MT. Furthermore, this marker is just as reliable as the NIHSS score but easier to assess. We therefore suggest that any stroke patient who displays head and/or gaze deviation should immediately be scheduled for vessel imaging and subsequently transported to a MT-competent center. Springer Berlin Heidelberg 2023-05-18 2023 /pmc/articles/PMC10421816/ /pubmed/37202605 http://dx.doi.org/10.1007/s00415-023-11775-2 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Communication
Schröter, Nils
Weiller, Antonia
Rijntjes, Michel
Harloff, Andreas
Urbach, Horst
Kukolja, Juraj
Bardutzky, Jürgen
Weiller, Cornelius
Beume, Lena-Alexandra
Identifying large vessel occlusion at first glance in telemedicine
title Identifying large vessel occlusion at first glance in telemedicine
title_full Identifying large vessel occlusion at first glance in telemedicine
title_fullStr Identifying large vessel occlusion at first glance in telemedicine
title_full_unstemmed Identifying large vessel occlusion at first glance in telemedicine
title_short Identifying large vessel occlusion at first glance in telemedicine
title_sort identifying large vessel occlusion at first glance in telemedicine
topic Original Communication
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10421816/
https://www.ncbi.nlm.nih.gov/pubmed/37202605
http://dx.doi.org/10.1007/s00415-023-11775-2
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